Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest.

Causes

Many things can cause heel pain. Most commonly seen at our Troy, MI office are heel spurs, which are small growths on the heel bone. Heel pain can be caused from heavy activities and increased weight that put extra pressure on feet. Dr. Weinert often treats heel pain in athletes, runners and women who are pregnant. There are other cases where Dr. Weinert has related a patient?s heel pain to arthritis, stress fractures, fractures, bone tumors, cysts, achilles tendonitis and Haglund's deformity. The main cause of heel pain is usually a biomechanical problem in the foot and it?s, in a nutshell, having a foot out of alignment. There are numerous conditions. One of the most prevalent is called talotarsal dislocation syndrome. What that is in lay terms is you?ve just got a misalignment of your ankle on your heel and as you bear weight you?re getting a collapse of the ankle on the heel causing the foot to be out of alignment. So the plantar fascia, bones, joints, and ligaments receive constant stress. This stress occurs at the point where the plantar fascia (the major tissue that connects your toes to your heel) meets the heel. Many patients explain the pain as being in the middle of the inside of the heel. As a patient bears weight, they get the collapse of the foot and that ligament pulls. And if you think of a rubber band constantly getting pulled on that area of the insertion on the heel, you eventually start getting some micro tears in that ligament and causing inflammation and pain specifically right there in middle area of the heel. Plantar fasciitis is also a common source of heel pain. The plantar fascia, a band of tissue that runs from your heel to your toes, can become strained and inflamed due to overuse and wear and tear. This band of tissue can only withstand so much pressure and when it gives way, the pain can be severe and requires immediate and effective treatment.

Symptoms

Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.

Diagnosis

A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.

Non Surgical Treatment

Treatment for plantar fasciitis - the vast majority of patients recover with conservative treatments (designed to avoid radical medical therapeutic measures or operative procedures) within months. Heel with ice-pack. Home care such as rest, ice-pack use, proper-fitting footwear and foot supports are often enough to ease heel pain. Non-steroidal anti-inflammatory drugs (NSAIDs) - medications with analgesic (pain reducing), antipyretic (fever reducing) effects. In higher doses they also have anti-inflammatory effects, they reduce inflammation (swelling). Non-steroidal distinguishes NSAIDs from other drugs which contain steroids, which are also anti-inflammatory. NSAIDs are non-narcotic (they do not induce stupor). For patients with plantar fasciitis they may help with pain and inflammation. Corticosteroids, a corticosteroid solution is applied over the affected area on the skin; an electric current is used to help absorption. Alternatively, the doctor may decide to inject the medication. However, multiple injections may result in a weakened plantar fascia, significantly increasing the risk of rupture and shrinkage of the fat pad covering the heel bone. Some doctors may use ultrasound to help them make sure they have injected in the right place Corticosteroids are usually recommended when NSAIDs have not helped. Physical therapy, a qualified/specialized physical therapist (UK: physiotherapist) can teach the patient exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel. The patient may also be taught how to apply athletic taping, which gives the bottom of the foot better support. Night splints, the splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them. Orthotics, insoles and orthotics (assistive devices) can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process. Extracorporeal shock wave therapy, sound waves are aimed at the affected area to encourage and stimulate healing. This type of therapy is only recommended for chronic (long-term) cases, which have not responded to conservative therapy.

Surgical Treatment

At most 95% of heel pain can be treated without surgery. A very low percentage of people really need to have surgery on the heel. It is a biomechanical problem and it?s very imperative that you not only get evaluated, but receive care immediately. Having heel pain is like having a problem with your eyes; as you would get glasses to correct your eyes, you should look into orthotics to correct your foot. Orthotics are sort of like glasses for the feet. They correct and realign the foot to put them into neutral or normal position to really prevent heel pain, and many other foot issues. Whether it be bunions, hammertoes, neuromas, or even ankle instability, a custom orthotic is something worth considering.

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body's need for rest and good nutrition. If obese, lose weight.